Michigan State University

2011-2012 Graduate Assistant Health Insurance Plan

LearnMore! 18008598452

www.aetnastudenthealth/msudirect.htm

NEW!! Lifetime Maximum of $250,000 per accident/illness. NEW!! Policy Year Prescription Maximum of $25,000. NEW!! Pre-existing conditions are covered with no waiting period. Coverage available from August 15, 2011 through August 31, 2012. MSU Student Health Services @ Olin is your first stop for care for students and spouses. See back for important referral information. Outpatient mental health benefits paid at 100% of the Negotiated Charge at an Aetna Preferred provider, and 100% of the Reasonable Charge at a Non-Preferred provider, after a $10 Copay per visit, up to maximum of 25 visits. Prescription Drugs covered at 100% of the Negotiated Charge at an Aetna Preferred pharmacy and 100% of the Reasonable Charge at a Non-Preferred pharmacy after a $5 per prescription Copay for Generic Prescription Drugs and a $10 per prescription Copay for Brand Name Prescription Drugs ($25,000 annual prescription maximum) Benefit level: 95% Preferred Care / 80% Non-Preferred Care Annual Deductible; $50 Preferred Care / $100 Non-Preferred Care / Annual out-of-pocket maximum $900 Preferred Care / $2,300 Non-Preferred Care Coverage for one annual gynecological examination including mammography services MSU subsidizes three physician office visits at MSU Student Health Services @ Olin. One of these visits may used for a general physical exam. These services are subsidized and provided by MSU and are not part of the student health insurance plan.

Who is Eligible?

Graduate Assistants (Premium paid by MSU) Dependents of Graduate Assistants are partially funded by Michigan State University. (See Premium Rates below)

* If MSU Student Health Services @ Olin is closed, seek non-emergency treatment at (hours vary by location): Delta Medical Center: Okemos, phone: (517) 349-4500; South Lansing, phone: (517) 882-7566; West Lansing, phone: (517) 321-8265 Haslett Redi-Care, Haslett Village Square, phone: (517) 339-2100 Lansing Urgent Care, 505 North Clipper Street, phone: (517) 333-9200 Red Cedar Valley Medicine, 6110 North Abbott, phone: (517) 332-5342 In a life-threatening situation or medical emergency - go directly to the nearest hospital emergency room.
2011-2012 Annual Premiums Graduate Assistants Total Premium MSU Cost* Student $ 1,853 $1,853 Student w/ spouse* $ 6,970 $4,053 Student w/ spouse, one child $ 9,772 $4,053 Student w/ spouse, all children $10,825 $4,053 Student w/ one child $ 4,655 $4,053 Student w/ all children $ 5,708 $4,053 Enrollment Periods Fall (8/15/11 - 12/31/11) Spring (1/1/12 - 5/11/12) Summer (5/12/12 - 8/31/12) 1st Quarter (8/15/11 - 11/14/11) 2nd Quarter (11/15/11- 2/14/12) 3rd Quarter (2/15/12 - 5/11/12) 4th Quarter (5/12/12- 8/31/12) Deadlines September 30, 2011 January 31, 2012 May 12, 2012 September 30, 2011 November 15, 2011 February 15, 2012 May 12, 2012

Student Cost $0 $2,917 $5,719 $6,772 $ 602 $1,655

*MSU will contribute $2,200 (annually) towards the cost of one dependent i.e. spouse or child, and $2,200 (annually) towards the cost of more than one dependent i.e. spouse and/or child(ren). Contact the MSU Human Resources Benefits office at (517) 353-4434 or e-mail studentinsurance@hr.msu.edu for more information website: http://www.hr.msu.edu/Benefits/Studenthealth/

The Michigan State University Student Health Insurance Plan is underwritten by Aetna Life Insurance Company (ALIC) and administered by Chickering Claims Administrators, Inc. Aetna Student HealthSM is the brand name for products and services provided by these companies and their applicable affiliated companies. This material is for information only. Health insurance plans contain exclusions and limitations. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professionals. Preferred providers are independent contractors and are neither employees nor agents of Aetna Life Insurance Company, Chickering Claims Administrators, Inc. or their affiliates. This plan will never pay more than a lifetime maximum of $250,000 or more that a policy year maximum of $25,000 for prescriptions. Additional plan maximums may also apply. Some illnesses may cost more to treat and health care providers may bill you for what the plan does not cover. Information is believed to be accurate as of the production date however, it is subject to change. Policy forms issued in OK include GR-96134. 2011 Aetna Inc. 15.03.426.1

IMPORTANT REFERRAL INFORMATION 2011-2012 Policy Year

If you are covered by AETNA STUDENT HEALTH, MSU Student Health Insurance Plan
If within 45 miles of the MSU East Lansing campus, all medical treatment must begin at MSU Student Health Services @ Olin (except treatment of an emergency medical condition, maternity, and mental health). A MSU Student Health Services @ Olin referral is required for any additional outside benefits to be paid. Referrals must be renewed each Policy Year. Outside of MSU Student Health Services @ Olin, there is an annual Deductible and Copay that will apply to all treatment. The Deductible is the amount of Covered Medical Expenses that are paid by each Covered Person during the Policy Year before benefits are paid. The Copay is a fee charged to a person for Covered Medical Expenses. MSU Student Health Services @ Olin will refer you to a Preferred Care Provider whenever possible. If you go to a Preferred Care (In-Network) Provider, an annual Deductible of $50 per person ($100/family) will apply. Once the Deductible has been met you will be responsible for a $10 per visit Copay for office visits, and 5% Co-insurance for all other charges (such as lab work, x-rays or hospital fees). Outpatient mental health benefits are payable at 100% of the Negotiated Charge with a $10 per visit copay, up to a maximum of 25 visits. PLEASE NOTE: Services for Medical students currently on rotation will be payable at the Preferred Care benefit level. To find a Preferred Care Provider visit Aetna Student Health's website: http://www.aetnastudenthealth.com/msudirect.htm or call their Customer Service department: 800-859-8452. If you choose to go to a Non-Preferred Care (Out-of-Network) Provider, an annual Deductible of $100 per person ($200/family) will apply. Once the Deductible has been met you will be responsible for all charges over 80% of Reasonable Charge. Outpatient mental health benefits are payable at 100% of the Reasonable Charge with a $10 per visit copay after the annual Deductible. Referrals must be renewed each Policy Year (beginning August 15th) for continuing treatment to be covered.

A separate referral is required for each diagnosed condition.

IF YOU HAVE QUESTIONS ABOUT YOUR MSU STUDENT HEALTH INSURANCE PLAN CONTACT EITHER ONE OF THE FOLLOWING: MSU Human Resources Benefits Office (517) 353-44341 E-mail: studentinsurance@hr.msu.edu http://www.hr.msu.edu/Benefits/StudentHealth/ Aetna Student Health 800-859-8452 http://www.aetnastudenthealth/msudirect.htm

Preferred providers are independent contractors and are neither employees nor agents of Aetna Life Insurance Company, Chickering Claims Administrators, Inc. or their affiliates. This material is for information only. The Michigan State University Student Health Insurance Plan is underwritten by Aetna Life Insurance Company (ALIC) and administered by Chickering Claims Administrators, Inc. Aetna Student HealthSM is the brand name for products and services provided by these companies and their applicable affiliated companies. This Plan is endorsed by Michigan State University.

The Michigan State University Student Health Insurance Plan may not cover all your health care expenses. The plan excludes coverage for certain services and contains limitations on the amounts it will pay. Please read the Michigan State University brochure carefully before deciding whether this plan is right for you. While this document and the Michigan State University brochure tell you about some of the important features of the plan, other features may be important to you and some further limit what the plan will pay. If you want to look at the full plan description, which is contained in the Master Policy issued to Michigan State University, you may view it the Human Resources office or you may contact us at 800-859-8452. 2011 Aetna Inc. 15.03.426.1